A sweeping draft legislative package from the bipartisan leaders of the Senate Health Committee seeks to lower health care costs by addressing surprise medical bills and adding transparency to drug prices, among other provisions.

Experts from Congress’s nonpartisan budget office testified Wednesday that a single-payer health care system would result in “many more” people with health insurance but would also be “potentially disruptive” and increase government control.

Polling by NPR finds that while rural Americans are mostly satisfied with life, there is a strong undercurrent of financial insecurity that can create very serious problems for many people living in rural communities.

NPR

Tuesday, May 21, 2019

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.

Joanna Stern wrote a fun article for The Wall Street Journal: "The Tech My Toddler Will Never Know: Six Gadgets Headed for the Graveyard." My immediate thought was about health tech's equivalent list. There certainly is a lot of health tech that should be headed to the graveyard, but, knowing healthcare's propensity to hang on to its technology way too long, I had to modify her more optimistic headline to say "should" instead of "will."

One can always hope. Here's my healthcare tech list:

1. Faxes: You knew it had to be at the top of the list. Anyone under thirty who knows how to work a fax machine probably works in healthcare. The reason faxes persist is because they supposedly offer some security advantages, but one suspects inertia plays at least a big a role. There are other options that can be equally "secure," while making the information digital.

2. Phone Trees: We've all had to call healthcare organizations -- doctors' offices, testing facility, health plans, etc. Most times, you first have to navigate a series of prompts to help specify why you are calling, presumably to get you closer to the right person. There are probably studies that show it saves money for the companies that use them, and perhaps some that even claim its saves customers time, but this is not a technology most people like. By 2030 I want my AI -- Alexa, Siri, etc. -- to deal directly with the companies' AI to spare me from phone trees.

3. Multiple health records: I have at least five distinct health records that I know of, only two of which communicate to the other at all. For people with more doctors and/or more complex health issues, I'm sure the situation is even worse. EHRs are old technology, the cable of healthcare. By 2030, we should each have a single health record that reflects the broad range of our health.

4. Stethoscopes: You've seen them. Your doctor probably has one. Find the oldest photographs of doctors that exist and you might find them with stethoscopes; they are that old.” It's not that they are useless, but as it is that there are better alternatives, such as handheld ultrasounds or even smartphone apps. For Pete's sake, people are working on real-life tricorders. By 2030, seriously, can we be using its 21st century alternatives?

5. Endoscopes: Perhaps you've had a colonoscopy or other endoscopic procedure; not much fun, right? We do a lot of them, they cost a lot of money (at least, in the U.S.), and they involve some impressive technology, but they're outdated. By 2030, we should be using things like ingestible pill cameras, with ingestible robots to take any needed samples or even conduct any microsurgery.

6. Chemotherapy: Chemotherapy is literally a lifesaver for many cancer patients, and a life-extender for many others. We're constantly getting new breakthroughs in it, allowing more remissions or more months of life. But it can pose a terrible burden -- physically, emotionally, and financially -- on the people getting it. Chemotherapy has been likened to carpet bombing, with significant collateral damage. Increasingly, there are alternatives that are more like "smart bombing" -- precision strikes that target only cancer cells, either killing or inhibiting them. By 2030, perhaps cancer patients won't fear the treatments almost as much as the cancer.

Healthcare certainly has no shortage of technology that we should hope today's toddlers will never have to use or experience. The above are just six suggestions, and you may have your own examples. We can make these happen, by 2030; the question is, will we?

This post is an abridged version of the posting in Kim Bellard’s blogsite. Click here to read the full posting.

The preterm birth rate rose for the fourth year in a row to 10.02% in 2018

The 2018 rate of low birthweight was unchanged from 2017 (8.28%)

In a Q&A session with report author Brady E. Hamilton, Ph.D. posted in the NCHStats blog, Hamilton is asked if there was a specific finding that surprised him, which he replied "the record lows reached for the general fertility rate, the total fertility rate and birth rates for females aged 15-19, 15-17, 18-19, and 20-24 are noteworthy. In addition, the magnitude of the continued decline in the birth rate for teens aged 15-19, down 7% from 2017 to 2018, is also historic." Hamilton was non-committal about the trend going forward, stating “these data do not answer the question of why the number of births dropped in 2018 or if the decline will continue.”

But assuming the trends do continue, which certainly the opinion of many, there are certainly major implications for healthcare, including this short-list:

Patients' risk of dying from medical mistakes, deadly infections and safety lapses have gotten much worse at the lowest ranked U.S. hospitals, underscoring Americans' need to check ratings of their local hospitals, new research released Wednesday shows.

McKinsey has just published various insights from their 2019 Consumer Social Determinants of Health Survey, which found that compared to those whose social need is met, respondents (2,010 surveyed with government program coverage or uninsured and below 250% of federal poverty level) that:

Reported food insecurity were 2.4 times more likely to report multiple ER visits, and 2,0 times more likely to be hospitalized

Reported unmet transportation needs were 2.6 times more likely to report multiple ER visits, and 2,2 times more likely to be hospitalized

Reported unmet community safety needs were 3.2 times more likely to report multiple ER visits

Encouraging news from the survey for health plan advocates of SDOH was that 85% of respondents reporting unmet social needs said they would use a social program offered by their health insurer. Regardless of their social needs, respondents were interested in these types of health plan SDOH programs as follows:

50% were interested in grocery store discounts for healthy foods

48% were interested in free memberships at local gyms

45% were interested in a wellness dollar account used towards wellness services of their choice

41% were interested in total reimbursement of home improvement purchases to address health issues

40% were interested in after-hours drop-in clinics at lower or no cost

Speaking of health plans, Kaiser Permanente has just announced their new Thrive Local initiative, a “a social care coordination platform” with “a network of public agencies and community-based organizations that will support” Kaiser “members to meet their social needs.”

Kaiser says that “starting this summer, closed-loop and bidirectional communication will provide confidence that referral, follow-up and ongoing patient/family engagement happen. Improved cross-sector collaboration and communication will also reduce the unintentional trauma and stigma that our patients and families may experience. Beyond Kaiser Permanente members and patients, community-based organizations will also benefit through improved decision support, automation, and relevance of the referrals they receive from their health system. This connectivity and interoperability between health care and social organizations and agencies will redefine the meaning of ‘provider network’ in this new world as the network of providers of health, health care, and social needs to address total health of our communities.”

Kaiser Permanente is partnering with Unite Us to launch the program, as tells us that Thrive Local within three years “will be available to all of Kaiser Permanente’s 12.3 million members and the 68 million people in the communities Kaiser Permanente serves.